Healthcare Provider Details

I. General information

NPI: 1194705772
Provider Name (Legal Business Name): ROGER J COTNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 SE ADAMS RD
BARTLESVILLE OK
74006-8448
US

IV. Provider business mailing address

226 SE DEBELL BLDG A
BARTLESVILLE OK
74006
US

V. Phone/Fax

Practice location:
  • Phone: 918-978-4275
  • Fax: 918-214-8051
Mailing address:
  • Phone: 918-333-7200
  • Fax: 918-331-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number05-38440
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4059
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: